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Histopathology request form

Histopathology request form pdf 2025

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The document is a histopathology request form from the Cellular Pathology department of Queen Elizabeth Hospital, Birmingham. It includes sections for patient details, specimen information, clinical history, and laboratory use instructions. The form is designed to facilitate the collection and processing of tissue specimens for pathological analysis.

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Click ‘Get Form’ to open the histopathology request form in the editor.
Begin by filling out the 'Patient Details' section. Enter the patient's forename, surname, registration number or NHS number, date of birth, and sex (M/F/U). Ensure all fields are completed accurately.
Next, provide the 'Date and Time Specimen Collected'. Use the calendar tool for easy date selection and input the time in hours and minutes.
Fill in the 'Hospital / Practice' details along with the corresponding code. Include the ward or department where applicable.
In the 'Clinical History' section, detail any relevant medical history, clinical findings, investigations, and previous treatments. This information is crucial for accurate diagnosis.
Complete the 'Requesting RMO' section by entering your GMC/GDC number, name, and signature. This validates your request.
Review all entered information for accuracy before saving or submitting your form through our platform.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (51 Votes)
2011	4 Satisfied (53 Votes)

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